Infertility is the absence of pregnancy after 1 year despite regular and unprotected sexual intercourse at least 2-3 times a week. Approximately 15% of married couples are infertile, 30% of them are women, 30% are men, and approximately 40% of them are responsible for both men and women.
Causes of female infertility:
In order for pregnancy to occur, the egg cell must be thrown into the abdominal cavity by the woman through ovulation, it must be caught by the strong tubes, it must be fertilized by encountering the sperm coming from the man in the tubes, and this fertilized egg must come into the uterus and nestle in the inner layer of the uterus, which we call endometrium. Simply in one of the events here. If a malfunction occurs, pregnancy will not occur and infertility will occur. It is instructive to investigate some points in the first interview for these patients; menstrual irregularity, hair growth, obesity, previous intra-abdominal or pelvic operations, previous chemotherapy or radiotherapy treatment, pain during menstruation or during intercourse, previous protection with an IUD, breast milk, smoking, thyroid hormone use. Related disorders and goiter disease are questioned.
Anovulation (lack of ovulation):
The most common cause of female infertility is the lack of ovulation. The most important sign that shows whether ovulation has occurred is the menstrual pattern. Many factors can cause ovulation disorders in women. Hormonal irregularities that may develop due to various organs, PCOS, excessive exercise, irregular diet, stress, smoking, alcohol may affect ovulation.
Tuba-peritoneal Factors:
The ovaries and tubes may be damaged due to previous infection, surgery, bleeding into the abdomen or endometriosis.
Hormonal disorders:
Hormonal disorders prevent ovulation. and may cause infertility by preventing the development of the uterine lining.
Hormonal disorders occurring in PCOS (Polycystic ovary syndrome), thyroid diseases, adrenal gland diseases, and pituitary gland diseases affect fertility.
Endometriosis. :
The endometrium, which is the uterine mucosa, is located outside the uterus. Endometriosis (chocolate cyst disease), which is the location and function of the disease, is mostly located in the ovaries. Endometriosis can have negative effects on ovulation, fertilization and implantation of the fertilized egg.
Miscarriages:
Previous miscarriages or elective abortions cause damage to the endometrium, the inner layer of the uterus. and may cause damage to the cervix. It may also disrupt the implantation of the fertilized egg into the uterus. Repeated miscarriages and abortions can create serious adhesions within the uterus. As a result of these adhesions, it is possible for menstrual bleeding to be absent or reduced (Asherman Syndrome, Intra uterine synechiae). In this case, pregnancy may not occur at all, and recurrent miscarriages may also occur (as a result of the decrease in the space required for the pregnancy to hold and feed in the uterus).
Uterine abnormalities:
Congenital structure and deformities in the uterus can lead to infertility. These structural disorders may cause a decrease in the blood supply of the uterine tissue (endometrium) and the uterus not growing sufficiently during pregnancy.
IMMUNIZATION - IUI - INSEMINATION (Intrauterine insemination)
< br /> Insemination (IUI) is a process performed to increase the number of sperm that will encounter the egg cell. Before this procedure, the mother is usually prepared for insemination by giving egg enhancing drugs such as clomiphene or some injections. After the sperm is collected from the prospective father, it is processed with special techniques in the laboratory. This prepared sperm is injected into the uterus with the help of a special small catheter. The procedure is usually painless but can sometimes cause abdominal cramping. IUI gives successful results in cases of low sperm count, decreased motility of sperm (decreased motility) and unexplained infertility. Vaccination also provides success in infertility due to impaired post coital test and cervical factor. The chance of successful pregnancy with insemination is between 20-25%.
In Vitro Fertilization (IVF)
In vitro fertilization assisted reproductive techniques, by taking the egg cells produced in the woman's body out of the body and using them in a laboratory with the man's sperm. It is based on the principle of fertilization in an laboratory environment and returning the resulting embryo into the woman's uterus. . In vitro fertilization or microinjection is applied to patients with blocked tubes, severe sperm disorders, endometriosis patients who have not been successful with other treatments, ovulation disorders, mild sperm disorders and unexplained infertility. In the past, techniques such as injecting sperm or embryo into tubes under laparoscopy (GIFT/ZIFT) were used. Modern medicine now prefers assisted reproductive techniques, in vitro fertilization (IVF) and microinjection (ICSI). The only difference between in vitro fertilization and microinjection is the method of fertilization. In the in vitro fertilization method, sperm and eggs are placed together and fertilization is expected to occur spontaneously, while in the microinjection method, a single sperm is injected into each egg with microscopic catheters.
How is it applied? ?
First of all, the ovaries are stimulated with the medications given to the woman, and then the formed eggs are taken out with a needle under the guidance of ultrasonography. As we mentioned before, in the in vitro fertilization process, fertilization is achieved by placing them side by side with sperm or by injecting them directly into the egg in microinjection. Then, 2-3 of the embryos formed are placed into the uterus 2-5 days after the egg retrieval process, and a pregnancy test is performed 10-14 days later.
ICSI (microinjection)
ICSI (microinjection) technique is used in cases where sperm count or motility is insufficient, sperm shapes are distorted, or other treatments are insufficient. A single sperm cell is injected into the egg obtained from the woman under a microscope using a very thin needle. In this way, fertilization is achieved in a laboratory environment. This technique mainly addresses three different categories of disorders. These are cases where sperm count or motility is lacking or sperm shapes (morphology) are distorted. In microinjection applications, fertilization rate is not related to sperm rate. Even in cases where there are a few sperm cells in the semen, the fertilization rate does not change (70 - 80%). With this technique, pregnancy can be achieved even with a few sperm cells. is. In cases where the mobility of sperm cells is insufficient, this technique can solve the difficulty of sperm in passing through the egg membrane. It has been known for many years that abnormal sperm shapes are a cause of infertility and that even in in vitro fertilization applications, fertilization does not occur or the fertilization rate is very low. Sperm shapes do not have a negative impact on fertilization and pregnancy rates in microinjection technique applications. The egg is fixed by sucking it with the help of a tube (pipette). Sperm is injected into the egg with a thin glass needle. Two days later, the fertilized egg (embryo) is placed into the uterus.
Can it be applied to patients who do not have any sperm?
Yes. Patients who do not have any sperm can be examined in three groups.
First In patients who do not have sperm due to the lack of hormones coming from the hypothalamus-pituitary, sperm formation can mostly be achieved with medical treatment and pregnancy can be achieved with insemination in these patients. . In patients who are not successful, microinjection is applied. There is usually no need to take a biopsy from the testicle in these patients.
Secondly is the absence of sperm production due to blocked ducts, although sperm production is normal. In these patients, sperm can be obtained with a needle or, if unsuccessful, by removing a small piece from the testicle.
Thirdly is the group in which sperm production in the testicle is impaired, and these patients constitute the majority of the patients. In these patients, sperm is first searched by entering the testicle with a needle and if no sperm is found, a biopsy is taken. On average, sperm can be found in 50% of patients.
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